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alspac_01_sdhah
MY DAUGHTER'S HEALTH AND HAPPINESS
All answers are confidential
This questionnaire is for the study child's chief carer
This questionnaire asks about your study child.
It should be completed by the chief carer.
To answer simply tick the box that is most accurate in your opinion.
If you cannot answer certain questions please put a line through them.
All answers are confidential.
THANK YOU FOR YOUR HELP
SECTION A: YOUR CHILD'S HEALTH
The health of your study child is still of great importance to us. We would like to know about any recent illnesses or medical treatment.

How would you assess the health of your study child nowadays? in the past month

1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell

How would you assess the health of your study child nowadays? in the past year

1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell

In the past 12 months has the doctor been called to your home because she was unwell?

1
Yes
2
No
If no, go to A3 below
If yes,
qc_A2_a == 1

how many times?

1
once
2
2 times
3
3-4 times
4
5 or more times
In the past 12 months, has she had the following infections?
-

1 - Yes

2 - No

measles
chicken pox
mumps
meningitis
cold sores
whooping cough
urinary infection
eye infection
ear infection
chest infection
tonsillitis or laryngitis
german measles
scarlet fever
influenza (flu)
a cold

In the past 12 months, has she had the following infections? In the past 12 months: other infection (please tick & describe)

1
Yes
2
No
Other
Has she had any of the following in the past 12 months?
-

1 - Yes and saw a doctor

2 - Yes but did not see doctor

3 - No did not have

diarrhoea
blood in the stools
vomiting
cough
high temperature
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache(s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
headache(s )
constipation
worm infection
head lice
scabies
asthma
eczema
hay fever

Has she had any of the following in the past 12 months? In the past 12 months: other (please tick and describe)

1
Yes and saw a doctor
2
Yes but did not see doctor
3
No did not have
Other

Has a doctor ever actually said that your study child has asthma or eczema?

1
Yes asthma
2
Yes eczema
3
Yes, asthma and eczema
4
No

In the past year has she had any periods when there was wheezing with whistling on her chest when she breathed?

1
Yes
2
No
If no, go to A6h on page 7
If yes,
qc_A6_a == 1

How many separate times has this happened in the past 12 months?

1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know

How many days altogether would you say she has wheezed in the past 12 months?

1
1 day
2
2-3 days
3
4-9 days
4
10-19 days
5
20 or more days
9
don't know

Was she breathless during any of these times?

1
Yes for all
2
Yes for some
3
No not at all

Did she have a cold during any of these times?

1
Yes for all
2
Yes for some
3
No not at all

How often, on average, has your child's sleep been disturbed due to wheezing in the past 12 months?

1
Never woken with wheezing
2
Less than one night per week
3
One or more nights per week

Has wheezing ever been severe enough to limit your child's speech to only one or two words at a time between breaths in the past 12 months?

1
Yes
2
No

In the past 12 months has her chest sounded wheezy during or after exercise?

1
Yes
2
No

In the past 12 months has she had a dry cough at night, apart from a cough associated with a cold or chest infection?

1
Yes
2
No

In the past 12 months has she had a problem with sneezing or a runny or blocked nose when she didn't have a cold or flu?

1
Yes
2
No
If no, go to A7 below
If yes,
qc_A6_k == 1

Has this nose problem been associated with itchy, watery eyes?

1
Yes
2
No

Did this nose problem happen in June or July?

1
Yes
2
No

Has she ever had hay fever?

1
Yes
2
No

Has your child ever had any itchy, dry skin rash in the joints and creases of her body (e.g. behind the knees, elbows, under the arms)?

1
Yes
2
No
If no, go to A9a on page 8
If yes,
qc_A8_a == 1

has she had it in the last year?

1
Yes
2
No
If no, go to A9a on page 8
If yes,
qc_A8_b == 1

how bad was this?

1
very bad
2
quite bad
3
mild
4
no problem

does she have this sort of rash now?

1
Yes
2
No

did the rash ever become sore and oozy?

1
Yes
2
No

was it made worse by irritants such as bubble bath, soap, wool or nylon clothing?

1
Yes
2
No

did the rash clear completely at any time in the last 12 months?

1
Yes
2
No

In the past 12 months how often, on average, has your child been kept awake at night by an itchy rash?

1
Never in the past 12 months
2
Less than one night per week
3
One or more nights per week

Does her skin get itchy when she gets sweaty? (e.g. in a hot room or when she has been playing?)

1
Yes
2
No

Has she ever had eczema?

1
Yes
2
No
How many days has she had to take off school for health reasons?
No. of days off school Guess? Please describe
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
For one or more infections (including colds, cough, flu)
For hospital investigation including admission
For other investigation(s)
How many days has she had to take off school for health reasons?
A10dg In the past 12 months: For other reasons Please describe: cs_qA10_d-g_X cs_Yes How many cs_Yes How many

1 - Yes

1 - Yes

For asthma 1 No. of days off school
For asthma 1 Guess?
For asthma 2 No. of days off school
For asthma 2 Guess?
For eczema or itchy rash 1 No. of days off school
For eczema or itchy rash 1 Guess?
For eczema or itchy rash 2 No. of days off school
For eczema or itchy rash 2 Guess?
For hay fever or allergic rhinitis 1 No. of days off school
For hay fever or allergic rhinitis 1 Guess?
For hay fever or allergic rhinitis 2 No. of days off school
For hay fever or allergic rhinitis 2 Guess?
SECTION B: PILLS AND POTIONS
Please indicate below any medicines (pills, syrups, inhalers, drops, sprays, suppositories, ointments etc including homeopathic and herbal remedies) that your study child has used in the last 12 months.
In the past 12 months medicine, pills drops or ointment for: Other conditions (Please tick and describe) cs_qB1_X cs_qB1 cs_Yes Generic text cs_qB1 cs_Yes Generic text cs_Yes Generic text cs_qB1

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

1 - Yes

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

1 - Yes

1 - Yes

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

Headache 1 -
Headache 1 Name of medicine etc.
Headache 1 How often?
Headache 2 -
Headache 2 Name of medicine etc.
Headache 2 How often?
Headache 3 -
Headache 3 Name of medicine etc.
Headache 3 How often?
Headache 4 -
Headache 4 Name of medicine etc.
Headache 4 How often?
Headache 5 -
Headache 5 Name of medicine etc.
Headache 5 How often?
Stomach ache 1 -
Stomach ache 1 Name of medicine etc.
Stomach ache 1 How often?
Stomach ache 2 -
Stomach ache 2 Name of medicine etc.
Stomach ache 2 How often?
Stomach ache 3 -
Stomach ache 3 Name of medicine etc.
Stomach ache 3 How often?
Stomach ache 4 -
Stomach ache 4 Name of medicine etc.
Stomach ache 4 How often?
Stomach ache 5 -
Stomach ache 5 Name of medicine etc.
Stomach ache 5 How often?
Earache 1 -
Earache 1 Name of medicine etc.
Earache 1 How often?
Earache 2 -
Earache 2 Name of medicine etc.
Earache 2 How often?
Earache 3 -
Earache 3 Name of medicine etc.
Earache 3 How often?
Earache 4 -
Earache 4 Name of medicine etc.
Earache 4 How often?
Earache 5 -
Earache 5 Name of medicine etc.
Earache 5 How often?
Other ache or pain 1 -
Other ache or pain 1 Name of medicine etc.
Other ache or pain 1 How often?
Other ache or pain 2 -
Other ache or pain 2 Name of medicine etc.
Other ache or pain 2 How often?
Other ache or pain 3 -
Other ache or pain 3 Name of medicine etc.
Other ache or pain 3 How often?
Other ache or pain 4 -
Other ache or pain 4 Name of medicine etc.
Other ache or pain 4 How often?
Other ache or pain 5 -
Other ache or pain 5 Name of medicine etc.
Other ache or pain 5 How often?
Vomiting 1 -
Vomiting 1 Name of medicine etc.
Vomiting 1 How often?
Vomiting 2 -
Vomiting 2 Name of medicine etc.
Vomiting 2 How often?
Vomiting 3 -
Vomiting 3 Name of medicine etc.
Vomiting 3 How often?
Vomiting 4 -
Vomiting 4 Name of medicine etc.
Vomiting 4 How often?
Vomiting 5 -
Vomiting 5 Name of medicine etc.
Vomiting 5 How often?
Diarrhoea 1 -
Diarrhoea 1 Name of medicine etc.
Diarrhoea 1 How often?
Diarrhoea 2 -
Diarrhoea 2 Name of medicine etc.
Diarrhoea 2 How often?
Diarrhoea 3 -
Diarrhoea 3 Name of medicine etc.
Diarrhoea 3 How often?
Diarrhoea 4 -
Diarrhoea 4 Name of medicine etc.
Diarrhoea 4 How often?
Diarrhoea 5 -
Diarrhoea 5 Name of medicine etc.
Diarrhoea 5 How often?
Constipation 1 -
Constipation 1 Name of medicine etc.
Constipation 1 How often?
Constipation 2 -
Constipation 2 Name of medicine etc.
Constipation 2 How often?
Constipation 3 -
Constipation 3 Name of medicine etc.
Constipation 3 How often?
Constipation 4 -
Constipation 4 Name of medicine etc.
Constipation 4 How often?
Constipation 5 -
Constipation 5 Name of medicine etc.
Constipation 5 How often?
Travel sickness 1 -
Travel sickness 1 Name of medicine etc.
Travel sickness 1 How often?
Travel sickness 2 -
Travel sickness 2 Name of medicine etc.
Travel sickness 2 How often?
Travel sickness 3 -
Travel sickness 3 Name of medicine etc.
Travel sickness 3 How often?
Travel sickness 4 -
Travel sickness 4 Name of medicine etc.
Travel sickness 4 How often?
Travel sickness 5 -
Travel sickness 5 Name of medicine etc.
Travel sickness 5 How often?
Insect bites 1 -
Insect bites 1 Name of medicine etc.
Insect bites 1 How often?
Insect bites 2 -
Insect bites 2 Name of medicine etc.
Insect bites 2 How often?
Insect bites 3 -
Insect bites 3 Name of medicine etc.
Insect bites 3 How often?
Insect bites 4 -
Insect bites 4 Name of medicine etc.
Insect bites 4 How often?
Insect bites 5 -
Insect bites 5 Name of medicine etc.
Insect bites 5 How often?
Bruising 1 -
Bruising 1 Name of medicine etc.
Bruising 1 How often?
Bruising 2 -
Bruising 2 Name of medicine etc.
Bruising 2 How often?
Bruising 3 -
Bruising 3 Name of medicine etc.
Bruising 3 How often?
Bruising 4 -
Bruising 4 Name of medicine etc.
Bruising 4 How often?
Bruising 5 -
Bruising 5 Name of medicine etc.
Bruising 5 How often?
A 'cold' 1 -
A 'cold' 1 Name of medicine etc.
A 'cold' 1 How often?
A 'cold' 2 -
A 'cold' 2 Name of medicine etc.
A 'cold' 2 How often?
A 'cold' 3 -
A 'cold' 3 Name of medicine etc.
A 'cold' 3 How often?
A 'cold' 4 -
A 'cold' 4 Name of medicine etc.
A 'cold' 4 How often?
A 'cold' 5 -
A 'cold' 5 Name of medicine etc.
A 'cold' 5 How often?
Cough 1 -
Cough 1 Name of medicine etc.
Cough 1 How often?
Cough 2 -
Cough 2 Name of medicine etc.
Cough 2 How often?
Cough 3 -
Cough 3 Name of medicine etc.
Cough 3 How often?
Cough 4 -
Cough 4 Name of medicine etc.
Cough 4 How often?
Cough 5 -
Cough 5 Name of medicine etc.
Cough 5 How often?
Sore throat 1 -
Sore throat 1 Name of medicine etc.
Sore throat 1 How often?
Sore throat 2 -
Sore throat 2 Name of medicine etc.
Sore throat 2 How often?
Sore throat 3 -
Sore throat 3 Name of medicine etc.
Sore throat 3 How often?
Sore throat 4 -
Sore throat 4 Name of medicine etc.
Sore throat 4 How often?
Sore throat 5 -
Sore throat 5 Name of medicine etc.
Sore throat 5 How often?
'Flu' 1 -
'Flu' 1 Name of medicine etc.
'Flu' 1 How often?
'Flu' 2 -
'Flu' 2 Name of medicine etc.
'Flu' 2 How often?
'Flu' 3 -
'Flu' 3 Name of medicine etc.
'Flu' 3 How often?
'Flu' 4 -
'Flu' 4 Name of medicine etc.
'Flu' 4 How often?
'Flu' 5 -
'Flu' 5 Name of medicine etc.
'Flu' 5 How often?
Infection requiring antibiotics 1 -
Infection requiring antibiotics 1 Name of medicine etc.
Infection requiring antibiotics 1 How often?
Infection requiring antibiotics 2 -
Infection requiring antibiotics 2 Name of medicine etc.
Infection requiring antibiotics 2 How often?
Infection requiring antibiotics 3 -
Infection requiring antibiotics 3 Name of medicine etc.
Infection requiring antibiotics 3 How often?
Infection requiring antibiotics 4 -
Infection requiring antibiotics 4 Name of medicine etc.
Infection requiring antibiotics 4 How often?
Infection requiring antibiotics 5 -
Infection requiring antibiotics 5 Name of medicine etc.
Infection requiring antibiotics 5 How often?
Athlete's foot 1 -
Athlete's foot 1 Name of medicine etc.
Athlete's foot 1 How often?
Athlete's foot 2 -
Athlete's foot 2 Name of medicine etc.
Athlete's foot 2 How often?
Athlete's foot 3 -
Athlete's foot 3 Name of medicine etc.
Athlete's foot 3 How often?
Athlete's foot 4 -
Athlete's foot 4 Name of medicine etc.
Athlete's foot 4 How often?
Athlete's foot 5 -
Athlete's foot 5 Name of medicine etc.
Athlete's foot 5 How often?
Wart or verrucca 1 -
Wart or verrucca 1 Name of medicine etc.
Wart or verrucca 1 How often?
Wart or verrucca 2 -
Wart or verrucca 2 Name of medicine etc.
Wart or verrucca 2 How often?
Wart or verrucca 3 -
Wart or verrucca 3 Name of medicine etc.
Wart or verrucca 3 How often?
Wart or verrucca 4 -
Wart or verrucca 4 Name of medicine etc.
Wart or verrucca 4 How often?
Wart or verrucca 5 -
Wart or verrucca 5 Name of medicine etc.
Wart or verrucca 5 How often?
Head lice 1 -
Head lice 1 Name of medicine etc.
Head lice 1 How often?
Head lice 2 -
Head lice 2 Name of medicine etc.
Head lice 2 How often?
Head lice 3 -
Head lice 3 Name of medicine etc.
Head lice 3 How often?
Head lice 4 -
Head lice 4 Name of medicine etc.
Head lice 4 How often?
Head lice 5 -
Head lice 5 Name of medicine etc.
Head lice 5 How often?
Worms 1 -
Worms 1 Name of medicine etc.
Worms 1 How often?
Worms 2 -
Worms 2 Name of medicine etc.
Worms 2 How often?
Worms 3 -
Worms 3 Name of medicine etc.
Worms 3 How often?
Worms 4 -
Worms 4 Name of medicine etc.
Worms 4 How often?
Worms 5 -
Worms 5 Name of medicine etc.
Worms 5 How often?
Eye infection 1 -
Eye infection 1 Name of medicine etc.
Eye infection 1 How often?
Eye infection 2 -
Eye infection 2 Name of medicine etc.
Eye infection 2 How often?
Eye infection 3 -
Eye infection 3 Name of medicine etc.
Eye infection 3 How often?
Eye infection 4 -
Eye infection 4 Name of medicine etc.
Eye infection 4 How often?
Eye infection 5 -
Eye infection 5 Name of medicine etc.
Eye infection 5 How often?
Psoriasis 1 -
Psoriasis 1 Name of medicine etc.
Psoriasis 1 How often?
Psoriasis 2 -
Psoriasis 2 Name of medicine etc.
Psoriasis 2 How often?
Psoriasis 3 -
Psoriasis 3 Name of medicine etc.
Psoriasis 3 How often?
Psoriasis 4 -
Psoriasis 4 Name of medicine etc.
Psoriasis 4 How often?
Psoriasis 5 -
Psoriasis 5 Name of medicine etc.
Psoriasis 5 How often?
Eczema 1 -
Eczema 1 Name of medicine etc.
Eczema 1 How often?
Eczema 2 -
Eczema 2 Name of medicine etc.
Eczema 2 How often?
Eczema 3 -
Eczema 3 Name of medicine etc.
Eczema 3 How often?
Eczema 4 -
Eczema 4 Name of medicine etc.
Eczema 4 How often?
Eczema 5 -
Eczema 5 Name of medicine etc.
Eczema 5 How often?
Asthma 1 -
Asthma 1 Name of medicine etc.
Asthma 1 How often?
Asthma 2 -
Asthma 2 Name of medicine etc.
Asthma 2 How often?
Asthma 3 -
Asthma 3 Name of medicine etc.
Asthma 3 How often?
Asthma 4 -
Asthma 4 Name of medicine etc.
Asthma 4 How often?
Asthma 5 -
Asthma 5 Name of medicine etc.
Asthma 5 How often?
Hay fever 1 -
Hay fever 1 Name of medicine etc.
Hay fever 1 How often?
Hay fever 2 -
Hay fever 2 Name of medicine etc.
Hay fever 2 How often?
Hay fever 3 -
Hay fever 3 Name of medicine etc.
Hay fever 3 How often?
Hay fever 4 -
Hay fever 4 Name of medicine etc.
Hay fever 4 How often?
Hay fever 5 -
Hay fever 5 Name of medicine etc.
Hay fever 5 How often?
Other allergies 1 -
Other allergies 1 Name of medicine etc.
Other allergies 1 How often?
Other allergies 2 -
Other allergies 2 Name of medicine etc.
Other allergies 2 How often?
Other allergies 3 -
Other allergies 3 Name of medicine etc.
Other allergies 3 How often?
Other allergies 4 -
Other allergies 4 Name of medicine etc.
Other allergies 4 How often?
Other allergies 5 -
Other allergies 5 Name of medicine etc.
Other allergies 5 How often?
Diabetes 1 -
Diabetes 1 Name of medicine etc.
Diabetes 1 How often?
Diabetes 2 -
Diabetes 2 Name of medicine etc.
Diabetes 2 How often?
Diabetes 3 -
Diabetes 3 Name of medicine etc.
Diabetes 3 How often?
Diabetes 4 -
Diabetes 4 Name of medicine etc.
Diabetes 4 How often?
Diabetes 5 -
Diabetes 5 Name of medicine etc.
Diabetes 5 How often?
Epilepsy 1 -
Epilepsy 1 Name of medicine etc.
Epilepsy 1 How often?
Epilepsy 2 -
Epilepsy 2 Name of medicine etc.
Epilepsy 2 How often?
Epilepsy 3 -
Epilepsy 3 Name of medicine etc.
Epilepsy 3 How often?
Epilepsy 4 -
Epilepsy 4 Name of medicine etc.
Epilepsy 4 How often?
Epilepsy 5 -
Epilepsy 5 Name of medicine etc.
Epilepsy 5 How often?
Sleeping 1 -
Sleeping 1 Name of medicine etc.
Sleeping 1 How often?
Sleeping 2 -
Sleeping 2 Name of medicine etc.
Sleeping 2 How often?
Sleeping 3 -
Sleeping 3 Name of medicine etc.
Sleeping 3 How often?
Sleeping 4 -
Sleeping 4 Name of medicine etc.
Sleeping 4 How often?
Sleeping 5 -
Sleeping 5 Name of medicine etc.
Sleeping 5 How often?
Fever, high temperature 1 -
Fever, high temperature 1 Name of medicine etc.
Fever, high temperature 1 How often?
Fever, high temperature 2 -
Fever, high temperature 2 Name of medicine etc.
Fever, high temperature 2 How often?
Fever, high temperature 3 -
Fever, high temperature 3 Name of medicine etc.
Fever, high temperature 3 How often?
Fever, high temperature 4 -
Fever, high temperature 4 Name of medicine etc.
Fever, high temperature 4 How often?
Fever, high temperature 5 -
Fever, high temperature 5 Name of medicine etc.
Fever, high temperature 5 How often?
Regularly: most days for at least 3 months, or several times every month
Few days: for a few days at a time for one or more episodes
Odd occasions: on a few odd occasions
Once or twice: on one or two isolated occasions only
Try to give the full name of the medicine and say how often it was used.

Please indicate below any medicines (pills, syrups, inhalers, drops, sprays, suppositories, ointments etc including homeopathic and herbal remedies) that your study child has used in the last 12 months. No medicines, pills, drops or ointment used at all

1
Yes
Please describe below any vitamins, minerals such as iron, or other supplements given for your study child's health in the past month and indicate how often they were taken.
(Please say which and give brand name) -

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

Generic text
Vitamins 1
Vitamins 2
Mineral supplements (e.g. iron, calcium) 1
Mineral supplements (e.g. iron, calcium) 2
Oil supplements (e.g. cod liver oil, evening primrose oil) 1
Oil supplements (e.g. cod liver oil, evening primrose oil) 2
Other tonic or supplement 1
Other tonic or supplement 2
Please describe below any treatment your child has taken for asthma or wheezing in the past month and indicate how often they were taken.
-

1 - Every day

2 - Most days

3 - About 1-2 times a week

4 - Less than once a week

5 - Not at all

"Reliever" inhaler
"Preventer" inhaler
Other inhaler or medicine for asthma
SECTION C: PROVIDING FOOD
This section asks you some of your opinions on providing food for your study child and how you keep a watch on what she eats.
Tick whether you agree or disagree with these statements:

I have to be sure that she does not eat too many sweets

1
Agree
2
Slightly agree
3
Neither agree nor disagree
4
Slightly disagree
5
Disagree

I have to be sure that she does not eat too many of her favourite foods

1
Agree
2
Slightly agree
3
Neither agree nor disagree
4
Slightly disagree
5
Disagree

I deliberately keep some foods out of her reach

1
Agree
2
Slightly agree
3
Neither agree nor disagree
4
Slightly disagree
5
Disagree

It's OK to offer sweets as a reward for good behaviour

1
Agree
2
Slightly agree
3
Neither agree nor disagree
4
Slightly disagree
5
Disagree

If I did not guide or regulate her eating she would eat too much

1
Agree
2
Slightly agree
3
Neither agree nor disagree
4
Slightly disagree
5
Disagree
How often do you do the following:
-

1 - Always

2 - Sometimes

3 - Never

4 - Not applicable

I insist that she eats all the food on her plate
If she does not finish all of the main course she is not allowed a pudding
I tell her off for playing or fiddling with food at mealtimes
I allow her to eat only at meal times, and not in between meals
Food for special occasions:

I cheer her up with something to eat if she is sad or upset

1
Always
2
Sometimes
3
Never
4
Not applicable

I like to take her out for a special meal when something good happens to her

1
Always
2
Sometimes
3
Never
4
Not applicable

I give her her favourite food when she is hurt or sick

1
Always
2
Sometimes
3
Never
4
Not applicable

I like to prepare a special meal for her when something good happens to her

1
Always
2
Sometimes
3
Never
4
Not applicable
Being watchful:

How often do you keep track of the snack foods that she eats?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never

How often do you keep track of the high-fat foods that she eats?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never

How often do you keep track of the sweets that she eats?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never
Food and weight:

How often have you commented to her about her eating?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never

How often have you commented to her about her weight or shape?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never

How often has she heard you complain about your own eating?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never

How often has she heard you complain about your own weight or shape?

1
Very often
2
Often
3
Sometimes
4
Not very often
5
Never

Do you think your study child is:

1
Very underweight
2
Moderately underweight
3
Slightly underweight
4
About the right weight
5
Slightly overweight
6
Moderately overweight
7
Very overweight
SECTION D: SEPARATION ANXIETY
Most children are particularly attached to one person or a few key people, looking to them for security, and turning to them when upset. They can be mum and dad, grandparents, favourite teachers, neighbours etc.

Who would you say your study child is particularly attached to? (tick all that apply)

2
No-one
If no-one, go to E1 on page 20
qc_D1 == 2
Else
Who would you say your study child is particularly attached to? (tick all that apply)
-

1 - Yes

mum/mother figure
dad/father figure
grandparent(s)
teacher
older brother or sister
aunt or uncle
family friend

Who would you say your study child is particularly attached to? (tick all that apply) other (please tick & describe)

1
Yes
Other
Most children have some worries about being separated from the people they are most attached to. We would like to know how your study child compares with other children of her age. We are interested in how she is usually - not the occasional "clingy day" or "off day".

Overall in the past month, has she been particularly worried about being separated from any of the people ticked in D1 above?

1
Yes
2
No
In the past month, compared with other children of the same age:
-

1 - No more than others

2 - A little more than others

3 - A lot more than others

Has she often worried about something unpleasant happening to these people, or about losing them?
Has she often worried that she might be taken away from any of them, e.g. by being kidnapped, taken to hospital or killed?
Has she often not wanted to go to school in case something nasty happened whilst she was still at school to a person(s) she is attached to? (Do not include reluctance to go to school for other reasons, e.g. fear of bullying or exams)
Has she worried about sleeping alone?
Has she come out of her bedroom at night to check on, or to sleep near any of these people?
Has she worried about sleeping in a strange place?
Has she been afraid of being alone in a room at home without one of the people she is attached to (even if you or they are close by)?
Has she had repeated nightmares or bad dreams about being separated from any of these people?
Has she had headaches, stomach aches or felt sick when she had to leave a person she is attached to, or when she knew it was about to happen?
Has being apart or the thought of being apart from a person she is attached to led to worry, crying, tantrums, clinginess or misery?
* If you have ticked 'a lot more than others', to ANY of the answers in D3, continue below. If not, go to E1 on page 20
qc_D3_a-j == 3

How long has she had worries about separation?

1
Less than 1 month
2
1-5 months
3
6 months or more

Was she like this before the age of 6?

1
Yes
2
No

How much do you think these worries have upset her?

1
not at all
2
only a little
3
quite a lot
4
a great deal
How much have these worries interfered with her day-to-day life?
-

1 - Not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family?
making and keeping friends?
learning or school work?
playing, hobbies, sports or other leisure activities?

Have these problems put a burden on you or the family as a whole?

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal
SECTION E: PARTICULAR FEARS
This section of the questionnaire is about any particular things or situations that your study child is scared of, even though they aren't really a danger to her. How is she usually - not on the occasional "off day"?
How scared is your study child about any of the following?
-

1 - Not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

insects, spiders, wasps, bees, mice, snakes, birds or any other creature
storms, thunder, heights or water
blood, injection or injury
dentists or doctors
other specific situations: lifts, tunnels, flying, driving, trains buses, small enclosed spaces
the dark

How scared is your study child about any of the following? She is scared of: any other specific fear? (please tick & describe)

1
Not at all
2
Only a little
3
Quite a lot
4
A great deal
Other

How scared is your study child about any of the following? She is scared of:

1
not particularly scared of anything
If so, go to F1 on page 23
qc_E1_h == 1
Else

Is this fear/are these fears a real nuisance to her, or to you, or to anyone else?

1
No
2
Perhaps
3
Definitely

How long has this fear (or the most severe of these fears) been going on?

1
less than a month
2
1-5 months
3
6 months or more

When your study child comes up against these things, or thinks she is about to come up against them, does she become anxious or upset?

1
yes, a lot
2
a little
3
no
If 'no' or 'a little' go to E5a below
qc_E4_a == 2 || qc_E4_a == 3
Else

Does this reaction happen every time (or almost every time) she comes up against such a situation?

1
Yes
2
No

How often does this fear (or the most severe of her fears) result in her becoming upset like this?

1
many times a day
2
most days
3
most weeks
4
every now and then

Does this fear lead to your study child avoiding the things she is afraid of?

1
yes, a lot
2
a little
3
no
If 'no' or 'a little' go to E6a below
qc_E5_a == 2 || qc_E5_a == 3
Else

Does this avoidance interfere with her everyday life?

1
yes, a lot
2
a little
3
no

Does she recognise that this fear is excessive or unreasonable?

1
no
2
perhaps
3
definitely

Is she upset that she has this fear?

1
no
2
perhaps
3
definitely

Has your study child's fear put a burden on you or the family as a whole?

1
not at all
2
only a little
3
quite a lot
4
a great deal

Space for comment

Generic text
SECTION F: SOCIAL FEARS

Overall does your study child particularly fear or avoid situations that involve a lot of people or meeting new people or doing things in front of people?

1
Yes
2
No
Has she been particularly afraid of any of the following situations over the last month?
-

1 - No

2 - A little

3 - A lot

4 - Hasn't done this in last month

Meeting new people
Meeting a lot of people such as at a party
Speaking in class
Reading out loud in front of others
Writing in front of others
Eating in front of others
* If you have ticked 'a lot' to ANY of the answers in F2 above, continue below. If not, go to G1 on page 26
qc_F2_a-f == 3

Are her fears of being with a lot of people mainly related to her fear of being separated from someone she is attached to, or are the fears still there even when she is with such a person?

1
mainly afraid only when separated from her special people
2
afraid even when with one of her special people

Is your study child just afraid in these situations with adults, or is she also afraid in situations that involve lots of children, or meeting new children?

1
only with adults
2
with both adults and children
3
only with children

Outside of these situations is your study child able to get on well enough with the adults and children she knows best?

1
Yes
2
No

Do you think her dislike of these situations is because she is afraid she will act in a way that will be embarrassing or show her up?

1
Yes, definitely
2
Not sure
3
No

Is it related to speech, reading or writing problems?

1
Yes
2
Not sure
3
No

Why else do you think she dislikes such situations?

Generic text

How long has she had this fear of being with lots of people, or doing things in front of lots of people, or meeting new people?

1
less than one month
2
1-5 months
3
6 months or more

What age did it begin?

1
under 6 years
2
6 years or older

When your study child is in one of these situations she fears, or when she thinks she is about to be in one, how anxious or upset does she usually become?

1
very anxious or upset
2
just a bit
3
not at all
If 'not at all' go to F10 on on page 25
qc_F8 == 3
Else

How often do these fears result in her becoming upset like this?

1
Many times a day
2
Most days
3
Most weeks
4
Every now and then

Does her fear lead to avoiding these situations?

1
yes, a lot
2
a little
3
no
If 'a little' or 'no' go to F10c below
qc_F10_a == 2 || qc_F10_a == 3
Else

Does this avoidance interfere with her everyday life?

1
no
2
a little
3
yes, a lot

Does she recognise that this fear is excessive or unreasonable?

1
no
2
perhaps
3
definitely

Is she upset about having this fear?

1
no
2
perhaps
3
definitely

Has your study child's fear of these situations put a burden on you or the family as a whole?

1
not at all
2
a little
3
quite a lot
4
a great deal

Space for comments

Long text
SECTION G: DISASTERS AND FRIGHTS

During your study child's lifetime has anything exceptionally stressful happened to her, that would really upset almost anyone, such as being involved in a terrible accident, or being abused or some other sort of disaster?

1
Yes
2
No
If no, go to H1 on page 29
If yes,
qc_G1 == 1

what was it? (please describe)

Generic text

how old was she ? ... years

Age

At the time, was she very distressed or did her behaviour change dramatically?

1
Yes
2
No

At present, is it affecting her behaviour, feelings or concentration?

1
Yes
2
No
Over the last month has your study child:
-

1 - No

2 - A little

3 - Yes, a lot

"relived" the event with vivid memories (flashbacks) of it?
had repeated distressing dreams of the event?
got upset if anything happened which reminded her of it?
tried to avoid thinking or talking about anything to do with the event?
tried to avoid activities, places or people that remind her of the event?
blocked out important details of the event from her memory?
shown much less interest in activities she used to enjoy?
expressed a smaller range of feelings than in the past, e.g. no longer able to express loving feelings?
had problems sleeping?
seemed irritable or angry?
had difficulty concentrating?
always been on the alert for possible dangers?
jumped at little noises or been easily startled in other ways?
* If you have ticked 'yes, a lot' to ANY answers in G4, continue below. If not, go to H1 on page 29
qc_G4_a-m == 3

How long after the event did these problems begin?

1
within 6 months
2
more than 6 months after the event

How long has she been having these problems?

1
Less than one month
2
1-2 months
3
3 months or more

How much have these problems upset or distressed her?

1
Not at all
2
only a little
3
quite a lot
4
a great deal
How much have these problems interfered with her day-to-day life?
-

1 - Not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family?
making and keeping friends?
learning or school work?
playing, hobbies, sports or other leisure activities?

Have these problems put a burden on you or the family as a whole?

1
Not at all
2
only a little
3
quite a lot
4
a great deal

Space for comments

Long text
SECTION H: COMPULSIONS AND OBSESSIONS
Many children have some habits or superstitions, such as not stepping on the cracks in the pavement, or needing to wear lucky clothes. It is also common for children to go through phases when they seem obsessed by one particular subject or activity. In this section we are interested in whether your study child has rituals or obsessions that go beyond this.

Overall, does she have rituals or obsessions that upset her, waste a lot of her time, or interfere with her ability to get on with everyday life?

1
Yes
2
No
In the past month has your study child been doing any of the following things over and over again even though she has already done them or doesn't need to do them at all?
-

1 - No

2 - Sometimes

3 - Often

Excessive cleaning e.g. hand washing, baths, showers, toothbrushing etc.
Other special measures to avoid dirt, germs or poisons
Checking things, e.g. doors, locks, oven, gas taps, electric switches
Repeating actions: e.g. going in/out door many times in a row, up/down from chair
Touching things or people in particular ways
Arranging things so they are just so, or exactly symmetrical
Counting to particular lucky numbers or avoiding unlucky numbers

In the past month has your study child been doing any of the following things over and over again even though she has already done them or doesn't need to do them at all? In the past month: Anything else? (please tick and describe)

1
No
2
Sometimes
3
Often
Other

In the past month, has she been concerned about: dirt, germs or poison

1
No
2
Sometimes
3
Often

In the past month, has she been concerned about: something terrible happening to herself or others e.g. illnesses, accidents, fires etc.

1
No
2
Sometimes
3
Often
* If you have ticked 'often' to ANY answers in H2 or H3, continue below. If not, go to J1 on page 32
qc_H2_a-g == 3 || qc_H2_h == 3 || qc_H3_a == 3 || qc_H3_b == 3
Space for you to describe any of these activities and concerns in more detail:

What does she do?

Generic text

How often does she do them?

Generic text

How long does each episode last?

Generic text

Have these compulsions or obsessions been present on most days for a period of at least two weeks?

1
Yes
2
No

Does she recognise that this behaviour or these thoughts are excessive or unreasonable?

1
Definitely
2
Somewhat
3
No

Does she try not to do them or think about them?

1
Definitely
2
Somewhat
3
No

Does she become upset because she has to do or think these things?

1
No, enjoys them
2
Neither enjoys it nor becomes upset
3
Sometimes a bit upset
4
Upset a great deal

Do these acts or thoughts last at least an hour a day on average?

1
Yes
2
No
Have these acts or thoughts interfered with:
-

1 - No, not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family
making and keeping friends
learning or school work
playing, hobbies, sports or other leisure activities

Have these problems put a burden on you or the family as a whole?

1
No, not at all
2
Only a little
3
Quite a lot
4
A great deal

Space for comments

Long text
SECTION J: ANXIETY IN GENERAL
Nearly all children have some worries, and these are naturally worse on some days than others, but some children have so many worries for so much of the time that it makes them really upset or interferes with their lives.

Does your study child ever worry?

1
Yes
2
No
If no, go to K1 on page 35
qc_J1 == 2
Else

Apart from any of the specific anxieties already mentioned on previous pages, has she worried so much over the last six months about so many things that it has really upset her or interfered with her life?

1
Definitely
2
Perhaps
3
No
Does she worry a lot about:
-

1 - No, not at all

2 - Sometimes

3 - Often

Past behaviour (e.g. Did I do that wrong? Have I upset someone? Have they forgiven me?)
School work, homework or tests/ examinations
Disasters (e.g. burglaries, muggings, fires, bombs)
Her own health
Bad things happening to others (e.g. family, friends, pets, the world)
The future (e.g. changing school, growing up, getting a job)

Does she worry a lot about: Any other worries? (please tick and describe)

1
No, not at all
2
Sometimes
3
Often
Other

In the past 6 months has she worried excessively on more days than not?

1
Yes
2
No

Does she find it difficult to control the worry?

1
Yes
2
No

Does worrying lead to her being restless, feeling keyed up, tense or on edge, or being unable to relax?

1
No not at all
2
Yes, but not on most days
3
Yes happens more days than not

Does worrying lead to her feeling tired or "worn out" more easily?

1
No not at all
2
Yes, but not on most days
3
Yes happens more days than not

Does worrying lead to difficulties in concentrating or her mind going blank?

1
No not at all
2
Yes, but not on most days
3
Yes happens more days than not

Does worrying lead to irritability?

1
No not at all
2
Yes, but not on most days
3
Yes happens more days than not

Does worrying lead to her looking physically tense (tense muscles)?

1
No not at all
2
Yes, but not on most days
3
Yes happens more days than not

Does worrying interfere with her sleep (e.g. difficulty in falling or staying asleep, or restless sleep, or doesn't have a good night's sleep)?

1
No not at all
2
Yes, but not on most days
3
Yes happens more days than not

Overall, how upset and distressed is your study child as a result of all her various worries?

1
Not at all
2
A little
3
Quite a lot
4
A great deal
Have these worries interfered with her day-to-day life?
-

1 - No, not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family
making and keeping friends
learning or school work
playing, hobbies, sports or other leisure activities

Have these worries put a burden on you or the family as a whole?

1
Not at all
2
A little
3
Quite a lot
4
A great deal

Space for comments

Long text
SECTION K: MOODS

In the past month, have there been times when your study child has been very sad, miserable, unhappy or tearful?

1
Yes
2
No
If no, go to K2 below
If yes,
qc_K1 == 1

Was there a period over this last month when she was really miserable nearly every day?

1
Yes
2
No

During the time when she was miserable, was she really miserable for most of the day?

1
Yes
2
No

How long did that period last?

1
Less than 2 weeks
2
2 weeks or more

Have you any idea what might have caused it?

1
Yes
2
No
If yes,
qc_K1_d == 1

please describe

Generic text

During this period, could she be cheered up?

1
easily
2
with difficulty/only briefly
3
not at all

In the past month, have there been times when your study child has been grumpy or irritable in a way that was out of character for her?

1
Yes
2
No
If no, go to K4 on page 36
If yes,
qc_K2 == 1

Has there been any period over this last month when she has been really grumpy or irritable nearly every day?

1
Yes
2
No

During the time when she was grumpy or irritable, was she really irritable for most of the day?

1
Yes
2
No

How long did that period last?

1
Less than 2 weeks
2
2 weeks or more

Have you any idea what might have caused it?

1
Yes
2
No
If yes,
qc_K3_d == 1

please describe

Generic text

Was the irritability improved by particular activities, friends coming around or anything else?

1
easily
2
with difficulty/only briefly
3
not at all

In the past month, have there been times when your study child lost interest in everything, or nearly everything, she normally enjoys doing?

1
Yes
2
No
If no, go to K5 on page 37
If yes,
qc_K4 == 1

Was there a period in the past month when she lost interest for nearly every day?

1
Yes
2
No

During the days when she had lost interest in things, was she like this for most of the day?

1
Yes
2
No

For how long did she lose interest in things?

1
Less than 2 weeks
2
2 weeks or more

Did this loss of interest happen during the same period when she was really miserable or irritable?

1
Yes
2
No

Just to recap, has she, in the past month been miserable/irritable or lacked interest in things she usually enjoys?

1
Yes
2
No
If no, go to L1 on page 39
If yes in the past month:
qc_k5 == 1

Did she have no energy and seem tired all the time?

1
Yes
2
No
3
Don't know

Was she eating either much more or much less than usual?

1
Yes
2
No
3
Don't know

Did she either lose weight or gain a lot of weight?

1
Yes
2
No
3
Don't know

Did she find it hard to get to sleep?

1
Yes
2
No
3
Don't know

Did she sleep too much?

1
Yes
2
No
3
Don't know

Was there any period when she was agitated or restless much of the time?

1
Yes
2
No
3
Don't know

Was there any period when she felt worthless, or unnecessarily guilty much of the time?

1
Yes
2
No
3
Don't know

Was there any period when she found it unusually hard to concentrate or to think things out?

1
Yes
2
No
3
Don't know

Did she think about death a lot?

1
Yes
2
No
3
Don't know

Did she ever talk about harming herself or killing herself?

1
Yes
2
No
3
Don't know

Did she ever try to harm herself or kill herself?

1
Yes
2
No
3
Don't know

Over the whole of her lifetime has she ever tried to harm herself or kill herself?

1
Yes
2
No
3
Don't know

Overall, how upset and distressed is your study child as a result of feeling miserable/irritable/ or lacking interest?

1
Not at all
2
A little
3
Quite a lot
4
A great deal
How has this interfered with her day-to-day life?
-

1 - No, not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family
making and keeping friends
learning or school work
playing, hobbies, sports or other leisure activities

Has your study child's feeling miserable/irritable/lacking interest put a burden on you or the family as a whole?

1
Not at all
2
A little
3
Quite a lot
4
A great deal

Space for comments

Long text
SECTION L: ATTENTION AND ACTIVITY
Nearly all children are overactive or lose concentration at times, but how does your study child compare with other children of her age? We are interested in how she is usually - not the occasional "off day".
Over the last 6 months:

Allowing for her age, do you think that your study child definitely has some problems with overactivity or poor concentration?

1
Yes
2
No
Please compare her behaviour in the last 6 months with other children of her age.
-

1 - No

2 - A little more than others

3 - A lot more than others

Does she often fidget?
Is it hard for her to stay sitting down for long?
Does she run or climb about when she shouldn't?
Does she find it hard to play or take part in other leisure activities without making a noise?
If she is rushing about does she find it hard to calm down when someone asks her to do so ?
In the last 6 months and compared with other children of her own age:
-

1 - No

2 - A little more than others

3 - A lot more than others

Does she often blurt out an answer before she has heard the question properly?
Is it hard for her to wait her turn?
Does she often butt in on other people's conversation or games?
Does she often go on talking even if she has been asked to stop or no one is listening?
In the last 6 months and compared with other children of her own age:
-

1 - No

2 - A little more than others

3 - A lot more than others

Does she often make careless mistakes or fail to pay attention to what she is supposed to be doing?
Does she often seem to lose interest in what she is doing?
Does she often not listen to what people are saying to her?
Does she often not finish a job properly?
Is it often hard for her to get herself organised to do something?
Does she often try to get out of things she would have to think about, such as homework?
Does she often lose things she needs for school or PE?
Is she easily distracted?
Is she often forgetful?
Has your study child's teacher complained in the last 6 months of problems with:
-

1 - No

2 - A little

3 - A lot

Fidgetiness, restlessness or overactivity
Poor concentration or being easily distracted
Acting without thinking about what she was doing, frequently butting in, or not waiting her turn
* If you have ticked 'a lot' to ANY answers in L2-L5, continue below. If not, go to M1 on page 42
qc_L2_a-e == 3 || qc_L3_a-d == 3 || qc_L4_a-i == 3 || qc_L5_a-c == 3

Have these problems been there for much of her life?

1
Yes
2
No

At what age did they start? ... years

Age

Thinking still of your child's difficulties with activity and attention, how much do you think they have upset or distressed her?

1
Not at all
2
A little
3
Quite a lot
4
A great deal
How have these difficulties interfered with her day-to-day life?
-

1 - No, not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family
making and keeping friends
learning or school work
playing, hobbies, sports or other leisure activities

Have these problems put a burden on you or the family as a whole?

1
Not at all
2
A little
3
Quite a lot
4
A great deal

Space for comments

Generic text
SECTION M: AWKWARD AND TROUBLESOME BEHAVIOUR
Awkward Behaviour
All children can be awkward and difficult at times - things like not doing as they are told, being irritable, having temper outbursts, or deliberately annoying other people. We are interested in how your study child is usually, and not just on occasional "off days".
In the last 6 months:

Overall, how do you think your study child compares with other children of her age as far as this sort of awkward behaviour is concerned?

1
Less troublesome than average
2
about average
3
more troublesome than average
In the last 6 months and compared with other children of the same age
-

1 - No more than others

2 - A little more than others

3 - A lot more than others

Has she had severe temper tantrums?
Has she argued with grown-ups?
Has she taken no notice of rules, or refused to do as she is told?
Has she seemed to do things to annoy other people on purpose?
Has she blamed others for her own mistakes or bad behaviour?
Has she been touchy and easily annoyed?
Has she been angry and resentful?
Has she been spiteful?
Has she tried to get her own back on people?
* If you have ticked 'a lot more than others' to ANY answers in M2, please continue. If not, go to M8 at the bottom of this page.
qc_M2_a-i == 3

Is this behaviour just with one person (e.g. teacher, brother) or with more than one?

1
Just with one person
2
More than one

Has your study child's awkward behaviour been there for much of her life?

1
Yes
2
No

What age did it start ? ... years

Age
Has it interfered with her day-to-day life?
-

1 - No, not at all

2 - Only a little

3 - Quite a lot

4 - A great deal

how well she gets on with you and the rest of the family?
making and keeping friends?
learning or school work?
playing, hobbies, sports or other leisure activities?

Have these problems put a burden on you or the family as a whole?

1
Not at all
2
A little
3
Quite a lot
4
A great deal

Has her teacher complained over the last 6 months of problems with this same kind of awkward behaviour or disruptiveness in class?

1
No
2
A little
3
A lot
Behaviour That Sometimes Gets Children Into Trouble - including dangerous, aggressive or antisocial behaviour. How has your study child been over the past 12 months? Answer how she is usually, and not just on occasional "off days".

Has she told lies to get things or favours from others, or to get out of things she was supposed to do?

1
No
2
Perhaps
3
Definitely
If definitely,
qc_M9_a == 3

has this been going on for the last 6 months?

1
Yes
2
No

Has she often started fights? (other than with brothers and sisters)

1
No
2
Sometimes
3
Often
If often,
qc_M9_b == 3

has this been going on for the last 6 months?

1
Yes
2
No

Has she bullied or threatened people?

1
No
2
Sometimes
3
Often
If often,
qc_M9_c == 3

has this been going on for the last 6 months?

1
Yes
2
No

Has she stayed out much later than she was supposed to?

1
No
2
Sometimes
3
Often
If often,
qc_M9_d == 3

has this been going on for the last 6 months?

1
Yes
2
No

Has she stolen things from the house, or other people's houses or shops or school?

1
No
2
Perhaps
3
Definitely
If definitely,
qc_M9_e == 3

has this happened in the last 6 months?

1
Yes
2
No

Has she run away from home or ever stayed away all night without your permission?

1
No
2
Yes once only
3
Yes, more than once
If yes,
qc_M9_f == 2 || qc_M9_f == 3

has this happened in the last 6 months?

1
Yes
2
No

Has she often played truant (bunked off) from school?

1
No
2
Perhaps
3
Definitely
If definitely,
qc_M9_g == 3

has this happened in the last 6 months?

1
Yes
2
No

Has your study child shown any other worrying behaviour in the past 12 months? (e.g. deliberately started a fire, vandalism, been deliberately cruel to another person, to animals or birds)?

1
Yes
2
No
If yes,
qc_M10 == 1

please describe

Generic text
SECTION N: OTHER PROBLEMS
This next section is about a variety of different aspects of your study child's behaviour and development.

In her first 3 years of life, was there anything that seriously worried you about: her speech development?

1
Yes
2
No
If no, go to N1b below
If yes,
qc_N1_a == 1

has this cleared up completely?

1
Some continuing problems
2
completely cleared up

In her first 3 years of life, was there anything that seriously worried you about: how she got on with other people?

1
Yes
2
No
If no, go to N1c below
If yes,
qc_N1_b == 1

has this cleared up completely?

1
Some continuing problems
2
completely cleared up

In her first 3 years of life, was there anything that seriously worried you about: any odd rituals or unusual habits that were very hard to interrupt?

1
Yes
2
No
If no, go to N2 below
If yes,
qc_N1_c == 1

has this cleared up completely?

1
Some continuing problems
2
completely cleared up

Nowadays, does she have any tics or twitches that she can't seem to control?

1
Yes
2
No
How much do the following descriptions apply to your study child?
-

1 - Not true

2 - Quite or sometimes true

3 - Very or often true

not aware of other people's feelings
does not realise when others are upset or angry
does not notice the effect of her behaviour on other members of the family
her behaviour often disrupts normal family life
very demanding of other people's time
difficult to reason with when upset
does not seem to understand social skills e.g. interrupts conversations constantly
does not pick up on body language
does not understand how she should behave when she is out e.g. in shops, or other people's houses
does not realise that she offends people with her behaviour
does not respond when told to do something
cannot follow a command unless it is carefully worded

Do you have any other comments or concerns?

1
Yes
2
No
(If yes,
qc_N3_m == 1

please tick and describe)

Other
SECTION O: GOING TO SCHOOL

What type of school does your study child attend?

1
primary/junior school
2
special school
3
private school
4
middle school
5
secondary school
6
does not go to school
7
other (please tick and describe)
Other

Does she have any problems that mean that the school should make (or has made) special arrangements for her (e.g. put her to the front of the class so that she can hear, provide extra teaching or help.)

1
Yes
2
No
If no, go to O4a on page 50
If yes,
qc_O2_a == 1

please describe

Generic text
Please indicate below which particular types of problem your child has which mean that special arrangements at school are needed (please tick all that apply).
-

1 - Yes

learning difficulty
speech
hearing
eyesight
reading difficulty
emotional or behavioural problem

Please indicate below which particular types of problem your child has which mean that special arrangements at school are needed (please tick all that apply). physical problem please describe

1
Yes
Generic text

Please indicate below which particular types of problem your child has which mean that special arrangements at school are needed (please tick all that apply). other (please tick and describe)

1
Yes
Other

Have you told the school about this?

1
yes, told this school
2
no, but told previous school
3
the school told me
4
no

Who else have you told? (please tick all that apply )

7
no one
If no-one, go to O3a below
qc_O2_d == 7
Else

Who else have you told? (please tick all that apply ) doctor

1
Yes

Who else have you told? (please tick all that apply ) local education authority

1
Yes

Who else have you told? (please tick all that apply ) health visitor

1
Yes

Who else have you told? (please tick all that apply ) other (please tick and describe)

1
Yes
Other

Have you ever asked the local education authority for an assessment of your child's needs?

1
Yes
2
No
If no, go to O4a below
If yes,
qc_O3_a == 1

Did the local education authority carry out an assessment?

1
Yes
2
No

Has any school or education authority ever said that your study child has Special Educational Needs?

1
Yes
2
No
If no, go to O6a on page 52
If yes,
qc_O4_a == 1

what do they say these needs are?

Generic text

how old was the child when you were first told this ? ... years

Age

Are you happy with the special needs provision that is being made for your child?

1
Yes, very happy
2
yes, quite happy
3
no, not happy
If no,
qc_O4_d == 3

what changes do you want?

Generic text

have you heard of the Special Educational Needs Code of Practice?

1
Yes
2
No

Does your study child have a 'statement' of special educational needs?

1
yes, has a statement
2
no, but is being assessed
3
no, was refused a statement
4
no, has never been considered for a statement
If never considered, go to O6a on page 52
qc_O5_a == 4
Else

If your child was ever considered for a statement please indicate how helpful you found the following people: The 'Named Person' (someone you agreed with the LEA could help you)

1
Very helpful
2
Quite helpful
3
Not helpful
4
Did not get help

If your child was ever considered for a statement please indicate how helpful you found the following people: An LEA 'Parent Partnership Officer'

1
Very helpful
2
Quite helpful
3
Not helpful
4
Did not get help

If your child was ever considered for a statement please indicate how helpful you found the following people: Someone from a voluntary group (please tick & describe the group)

1
Very helpful
2
Quite helpful
3
Not helpful
4
Did not get help
Generic text

If your child was ever considered for a statement please indicate how helpful you found the following people: Someone else (please tick & describe)

1
Very helpful
2
Quite helpful
3
Not helpful
4
Did not get help
Other
[LEA = local education authority]

Have you ever appealed to the Special Educational Needs Tribunal?

1
Yes
2
No
If no, go to O7 on page 53
If yes,
qc_O6_a == 1

was your appeal heard by the Tribunal?

1
Yes
2
No, but will be
3
No
If no, go to O7 on page 53
If yes,
qc_O6_b== 1

what was the outcome?

1
waiting for result
2
turned down
3
successful
If successful,
qc_O6_c == 3

do you think the LEA has carried out the Tribunal's order?

1
Yes
2
No
If no,
qc_O6_c_i == 2

please say how you think the local education authority has failed to carry out the order:

Generic text

If you think your child has special needs, do you have any suggestions for improvements in the way they have been handled by the special needs system?

1
Yes
2
No
If yes,
qc_O7 == 1

please describe

Generic text

Has your study child ever had speech (or language) therapy?

1
yes
2
no, but is on waiting list
3
no, never
If no, go to O9 below
If yes,
qc_O8_a == 1

do you think her difficulties improved as a result?

1
Yes
2
No

is she still having speech therapy?

1
Yes
2
No

do you think she should still be receiving speech and language therapy?

1
Yes
2
No

How well do you feel your child's school keeps you informed? about her school work

1
Very well informed
2
Quite well informed
3
Not well informed

How well do you feel your child's school keeps you informed? about her behaviour

1
Very well informed
2
Quite well informed
3
Not well informed

How well do you feel your child's school keeps you informed? about other aspects (please tick and describe)

1
Very well informed
2
Quite well informed
3
Not well informed
Other

How does she feel about school? She looks forward to going

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She enjoys it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She is stimulated by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She is frightened by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She talks about her friends

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She seems bored by school

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She likes her teacher(s)

1
Always
2
Usually
3
Sometimes
4
Not at all

How much at school do you think she likes: reading

1
She likes it a lot
2
She quite likes it
3
She does not like it
4
Is unable to do

How much at school do you think she likes: maths

1
She likes it a lot
2
She quite likes it
3
She does not like it
4
Is unable to do

How much at school do you think she likes: writing

1
She likes it a lot
2
She quite likes it
3
She does not like it
4
Is unable to do

How much at school do you think she likes: games

1
She likes it a lot
2
She quite likes it
3
She does not like it
4
Is unable to do

How much at school do you think she likes: discussion

1
She likes it a lot
2
She quite likes it
3
She does not like it
4
Is unable to do

How much at school do you think she likes: other (please tick and describe)

1
She likes it a lot
2
She quite likes it
3
She does not like it
4
Is unable to do
Other

Are you interested in what your child does at school?

1
Yes very
2
Yes mostly
3
No, not really

Are you happy with the teaching your daughter is getting at school?

1
Yes very
2
Yes mostly
3
No, not really

Are you happy with the progress your daughter is making at school?

1
Yes very
2
Yes mostly
3
No, not really

This questionnaire was completed by: (tick all that apply) child's biological mother

1
Yes

This questionnaire was completed by: (tick all that apply) child's mother figure

1
Yes

This questionnaire was completed by: (tick all that apply) child's biological father

1
Yes

This questionnaire was completed by: (tick all that apply) child's father figure

1
Yes

This questionnaire was completed by: (tick all that apply) study child

1
Yes

This questionnaire was completed by: (tick all that apply) someone else (please tick and describe

1
Yes
Other

Please give the date on which you completed this questionnaire:

Generic date

Please give the date of birth of your child:

Date of birth
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comment you would like to make

Long text
NB Please remember we cannot reply to any comment unless you sign it.
When completed, please return the questionnaire to: Professor Jean Golding Children of the Nineties - ALSPAC Institute of Child Health
The illustrations in this questionnaire have been reproduced from pictures produced by children who are part of the "Children of the 90s" research initiative.
End

alspac_01_sdhah

MY DAUGHTER'S HEALTH AND HAPPINESS
All answers are confidential
This questionnaire is for the study child's chief carer
This questionnaire asks about your study child.
It should be completed by the chief carer.
To answer simply tick the box that is most accurate in your opinion.
If you cannot answer certain questions please put a line through them.
All answers are confidential.
THANK YOU FOR YOUR HELP

SECTION A: YOUR CHILD'S HEALTH

The health of your study child is still of great importance to us. We would like to know about any recent illnesses or medical treatment.
How would you assess the health of your study child nowadays? in the past month
1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell
How would you assess the health of your study child nowadays? in the past year
1
very healthy, no problems
2
healthy, but a few minor problems
3
sometimes quite ill
4
almost always unwell
In the past 12 months has the doctor been called to your home because she was unwell?
1
Yes
2
No
If no, go to A3 below
how many times?
1
once
2
2 times
3
3-4 times
4
5 or more times

In the past 12 months, has she had the following infections?

-

1 - Yes

2 - No

measles
chicken pox
mumps
meningitis
cold sores
whooping cough
urinary infection
eye infection
ear infection
chest infection
tonsillitis or laryngitis
german measles
scarlet fever
influenza (flu)
a cold
In the past 12 months, has she had the following infections? In the past 12 months: other infection (please tick & describe)
1
Yes
2
No
Other

Has she had any of the following in the past 12 months?

-

1 - Yes and saw a doctor

2 - Yes but did not see doctor

3 - No did not have

diarrhoea
blood in the stools
vomiting
cough
high temperature
ear ache
ear discharge (pus not wax)
convulsions/fits
stomach ache(s)
rash
wheezing
breathlessness
episodes of stopping breathing
an accident
headache(s )
constipation
worm infection
head lice
scabies
asthma
eczema
hay fever
Has she had any of the following in the past 12 months? In the past 12 months: other (please tick and describe)
1
Yes and saw a doctor
2
Yes but did not see doctor
3
No did not have
Other
Has a doctor ever actually said that your study child has asthma or eczema?
1
Yes asthma
2
Yes eczema
3
Yes, asthma and eczema
4
No
In the past year has she had any periods when there was wheezing with whistling on her chest when she breathed?
1
Yes
2
No
If no, go to A6h on page 7
How many separate times has this happened in the past 12 months?
1
once
2
twice
3
3-4 times
4
5 or more times
9
don't know
How many days altogether would you say she has wheezed in the past 12 months?
1
1 day
2
2-3 days
3
4-9 days
4
10-19 days
5
20 or more days
9
don't know
Was she breathless during any of these times?
1
Yes for all
2
Yes for some
3
No not at all
Did she have a cold during any of these times?
1
Yes for all
2
Yes for some
3
No not at all
How often, on average, has your child's sleep been disturbed due to wheezing in the past 12 months?
1
Never woken with wheezing
2
Less than one night per week
3
One or more nights per week
Has wheezing ever been severe enough to limit your child's speech to only one or two words at a time between breaths in the past 12 months?
1
Yes
2
No
In the past 12 months has her chest sounded wheezy during or after exercise?
1
Yes
2
No
In the past 12 months has she had a dry cough at night, apart from a cough associated with a cold or chest infection?
1
Yes
2
No
In the past 12 months has she had a problem with sneezing or a runny or blocked nose when she didn't have a cold or flu?
1
Yes
2
No
If no, go to A7 below
Has this nose problem been associated with itchy, watery eyes?
1
Yes
2
No
Did this nose problem happen in June or July?
1
Yes
2
No
Has she ever had hay fever?
1
Yes
2
No
Has your child ever had any itchy, dry skin rash in the joints and creases of her body (e.g. behind the knees, elbows, under the arms)?
1
Yes
2
No
If no, go to A9a on page 8
has she had it in the last year?
1
Yes
2
No
If no, go to A9a on page 8
how bad was this?
1
very bad
2
quite bad
3
mild
4
no problem
does she have this sort of rash now?
1
Yes
2
No
did the rash ever become sore and oozy?
1
Yes
2
No
was it made worse by irritants such as bubble bath, soap, wool or nylon clothing?
1
Yes
2
No
did the rash clear completely at any time in the last 12 months?
1
Yes
2
No
In the past 12 months how often, on average, has your child been kept awake at night by an itchy rash?
1
Never in the past 12 months
2
Less than one night per week
3
One or more nights per week
Does her skin get itchy when she gets sweaty? (e.g. in a hot room or when she has been playing?)
1
Yes
2
No
Has she ever had eczema?
1
Yes
2
No

How many days has she had to take off school for health reasons?

No. of days off school Guess? Please describe
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
How many

1 - Yes

Generic textHow many

1 - Yes

Generic text

1 - Yes

Generic textHow many
For one or more infections (including colds, cough, flu)
For hospital investigation including admission
For other investigation(s)

How many days has she had to take off school for health reasons?

A10dg In the past 12 months: For other reasons Please describe: cs_qA10_d-g_X cs_Yes How many cs_Yes How many

1 - Yes

1 - Yes

For asthma 1 No. of days off school
For asthma 1 Guess?
For asthma 2 No. of days off school
For asthma 2 Guess?
For eczema or itchy rash 1 No. of days off school
For eczema or itchy rash 1 Guess?
For eczema or itchy rash 2 No. of days off school
For eczema or itchy rash 2 Guess?
For hay fever or allergic rhinitis 1 No. of days off school
For hay fever or allergic rhinitis 1 Guess?
For hay fever or allergic rhinitis 2 No. of days off school
For hay fever or allergic rhinitis 2 Guess?

SECTION B: PILLS AND POTIONS

Please indicate below any medicines (pills, syrups, inhalers, drops, sprays, suppositories, ointments etc including homeopathic and herbal remedies) that your study child has used in the last 12 months.

In the past 12 months medicine, pills drops or ointment for: Other conditions (Please tick and describe) cs_qB1_X cs_qB1 cs_Yes Generic text cs_qB1 cs_Yes Generic text cs_Yes Generic text cs_qB1

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

1 - Yes

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

1 - Yes

1 - Yes

1 - Regularly

2 - Few days

3 - Odd occasions

4 - Once or twice

Headache 1 -
Headache 1 Name of medicine etc.
Headache 1 How often?
Headache 2 -
Headache 2 Name of medicine etc.
Headache 2 How often?
Headache 3 -
Headache 3 Name of medicine etc.
Headache 3 How often?
Headache 4 -
Headache 4 Name of medicine etc.
Headache 4 How often?
Headache 5 -
Headache 5 Name of medicine etc.
Headache 5 How often?
Stomach ache 1 -
Stomach ache 1 Name of medicine etc.
Stomach ache 1 How often?
Stomach ache 2 -
Stomach ache 2 Name of medicine etc.
Stomach ache 2 How often?
Stomach ache 3 -
Stomach ache 3 Name of medicine etc.
Stomach ache 3 How often?
Stomach ache 4 -
Stomach ache 4 Name of medicine etc.
Stomach ache 4 How often?
Stomach ache 5 -
Stomach ache 5 Name of medicine etc.
Stomach ache 5 How often?
Earache 1 -
Earache 1 Name of medicine etc.
Earache 1 How often?
Earache 2 -
Earache 2 Name of medicine etc.
Earache 2 How often?
Earache 3 -
Earache 3 Name of medicine etc.
Earache 3 How often?
Earache 4 -
Earache 4 Name of medicine etc.
Earache 4 How often?
Earache 5 -
Earache 5 Name of medicine etc.
Earache 5 How often?
Other ache or pain 1 -
Other ache or pain 1 Name of medicine etc.
Other ache or pain 1 How often?
Other ache or pain 2 -
Other ache or pain 2 Name of medicine etc.
Other ache or pain 2 How often?
Other ache or pain 3 -
Other ache or pain 3 Name of medicine etc.
Other ache or pain 3 How often?
Other ache or pain 4 -
Other ache or pain 4 Name of medicine etc.
Other ache or pain 4 How often?
Other ache or pain 5 -
Other ache or pain 5 Name of medicine etc.
Other ache or pain 5 How often?
Vomiting 1 -
Vomiting 1 Name of medicine etc.
Vomiting 1 How often?
Vomiting 2 -
Vomiting 2 Name of medicine etc.
Vomiting 2 How often?
Vomiting 3 -
Vomiting 3 Name of medicine etc.
Vomiting 3 How often?
Vomiting 4 -
Vomiting 4 Name of medicine etc.
Vomiting 4 How often?
Vomiting 5 -
Vomiting 5 Name of medicine etc.
Vomiting 5 How often?
Diarrhoea 1 -
Diarrhoea 1 Name of medicine etc.
Diarrhoea 1 How often?
Diarrhoea 2 -
Diarrhoea 2 Name of medicine etc.
Diarrhoea 2 How often?
Diarrhoea 3 -
Diarrhoea 3 Name of medicine etc.
Diarrhoea 3 How often?
Diarrhoea 4 -
Diarrhoea 4 Name of medicine etc.
Diarrhoea 4 How often?
Diarrhoea 5 -
Diarrhoea 5 Name of medicine etc.
Diarrhoea 5 How often?
Constipation 1 -
Constipation 1 Name of medicine etc.
Constipation 1 How often?
Constipation 2 -
Constipation 2 Name of medicine etc.
Constipation 2 How often?
Constipation 3 -
Constipation 3 Name of medicine etc.
Constipation 3 How often?
Constipation 4 -
Constipation 4 Name of medicine etc.
Constipation 4 How often?
Constipation 5 -
Constipation 5 Name of medicine etc.
Constipation 5 How often?
Travel sickness 1 -
Travel sickness 1 Name of medicine etc.
Travel sickness 1 How often?
Travel sickness 2 -
Travel sickness 2 Name of medicine etc.
Travel sickness 2 How often?
Travel sickness 3 -
Travel sickness 3 Name of medicine etc.
Travel sickness 3 How often?
Travel sickness 4 -
Travel sickness 4 Name of medicine etc.
Travel sickness 4 How often?
Travel sickness 5 -
Travel sickness 5 Name of medicine etc.
Travel sickness 5 How often?
Insect bites 1 -
Insect bites 1 Name of medicine etc.
Insect bites 1 How often?
Insect bites 2 -
Insect bites 2 Name of medicine etc.
Insect bites 2 How often?
Insect bites 3 -
Insect bites 3 Name of medicine etc.
Insect bites 3 How often?
Insect bites 4 -
Insect bites 4 Name of medicine etc.
Insect bites 4 How often?
Insect bites 5 -
Insect bites 5 Name of medicine etc.
Insect bites 5 How often?
Bruising 1 -
Bruising 1 Name of medicine etc.
Bruising 1 How often?
Bruising 2 -
Bruising 2 Name of medicine etc.
Bruising 2 How often?
Bruising 3 -